ArticleInternational orthopaedics2019
Complications in patients with intramedullary nails: a case series from a single Cambodian surgical clinic.
Article in International orthopaedics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 5 citations in OpenAlex.
- Treatment of Infection After Tibial Intramedullary Nailing With Bone Distraction Combined With Free Anterolateral Thigh Flap for Concomitant Soft-tissue Defect.Plastic and reconstructive surgery. Global open · 2024Article
- Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries?International orthopaedics · 2024Article
- Neglected Broken Femoral Intramedullary Nail Resulting in an Urethrocutaneous Fistula.Indian journal of orthopaedics · 2022Article
- Finite element analysis of biomechanical effects of residual varus/valgus malunion after femoral fracture on knee joint.International orthopaedics · 2021Article
- Can surgical site infections be controlled through microbiological surveillance? A three-year laboratory-based surveillance at an orthopaedic unit, retrospective observatory study.International orthopaedics · 2019Observational
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Authors and funding
9 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeSince its development in 1999, the SIGN nail has been used in over 190,000 surgeries spanning 55 countries. To date, however, evaluation of SIGN nail outcomes has been limited to small prospective studies or large retrospective studies using SIGN's online database. This study uses the experience of a single, independent Cambodian surgical clinic to characterize common complications, provide commentary on ways to reduce the risk of those complications, and determine whether several observed nail fractures were due to metallurgic defects.
methodsClinic medical records were queried to identify complications in patients with SIGN nails. Data was abstracted including age, sex, mechanism of injury, and latency between injury, primary implantation, and presentation with a complication. Two nails that fractured in vivo were analyzed by light microscopy, scanning electron microscopy, and polarized light microscopy after chemical etching.
resultsFifty-four complications in 51 patients were identified. The most common complications were non-union (n = 26, 48%), infection (n = 16, 30%), flexion limitation (n = 11, 20%), nail fracture (n = 4, 7%), delayed union (n = 4, 7%), and malunion (n = 4, 7%). Other complications included broken or floating screws. Fractography revealed that two of the fractured nails most likely failed by fatigue followed by fast fracture at the site of non-union. We found no evidence of intrinsic nail defects. We identified multiple inconsistencies between SIGN's database and independent clinic records.
conclusionsNon-union and infection were common relative to all complications. Based on radiographic review, risk for non-union and malunion can be minimized by selecting an appropriate nail diameter, using multiple interlocking screws, and employing the correct implant and approach for fracture morphology when using SIGN nails. Nail fractures were unlikely to be caused by metallurgical flaws. Further study is necessary to determine the appropriate management of non-unions based on radiographic and clinical factors.
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